398 THE INFERIOR EXTREMITY 



THE INFERIOR EXTREMITY. 



THE FRONT OF THE THIGH. 



Surface Landmarks. The bony points of the pelvis have 

 already been described (pp. 237 and 239). 



> ... The sartorius muscle is rendered prominent when the hip and 

 knee-joints are flexed and the limb is rotated laterally. It can 

 then be recognised as a ridge passing from the anterior superior 

 iliac spine obliquely to the medial side of the thigh. To its 

 lateral side, just distal to the anterior superior spine, the ringers 

 can be inserted into a depression, which is bounded laterally 

 by the tensor Jascicz latce. This depression overlies the straight 

 head of the rectus femoris which lies on the anterior aspect of 

 the capsule of the hip- joint and it is rendered more distinct 

 when the patient flexes the thigh with the knee extended. 



The tendon of the adductor longus, which arises in the angle 

 between the pubic crest and the symphysis, can be seen when 

 the thigh is adducted against resistance. In obese subjects, 

 though not always visible, the tendon can be felt and traced 

 to the pubis. The tendon may serve as a guide to the pubic 

 tubercle, the position of which must be determined in distin- 

 guishing a femoral from a small inguinal hernia. The neck of 

 a femoral hernia lies below the tubercle, while that of an inguinal 

 hernia is situated above it. 



Superficial Vessels. -The great saphenous vein (p. 447) 

 lies in the superficial fascia on the antero-medial side of the 

 thigh, and, having received numerous tributaries, pierces the 

 fascia cribrosa, which partially closes the fossa ovalis (saphenous 

 opening), to join the femoral vein. 



Its proximal part is commonly exposed by the surgeon in 

 the removal of varicose veins, and is most easily found by 

 making a transverse incision through the skin and fascia at the 

 distal border of the fossa ovalis (p. 401), the patient's limb 

 being kept slightly abducted and laterally rotated. 



At the point where the great saphenous joins the femoral 

 vein there is not uncommonly a dilatation, which gives rise to a 

 visible swelling. This may be mistaken for a femoral hernia, 

 as there is an impulse on coughing and the swelling disappears 



